Shelto: Getting health coverage to the people

By Audrey Shelto/Guest Columnist

Sunday

Oct 7, 2018 at 3:14 AMOct 7, 2018 at 3:14 AM

Health insurance coverage, whether private or public, is vitally important. People who have it generally have far better health outcomes and experience less financial burden in getting health care. For people who have coverage, care is more often provided in the right setting at the right time. Disease often is detected sooner, and treatment is more consistent.

Health coverage is also important to us as a society. It lowers cost because care is more often provided in lower-cost setting like doctors’ offices – when appropriate – rather than a hospital emergency department. It is for both of these reasons that Massachusetts policymakers have worked so hard to make sure as many people as possible have health coverage.

Sometimes, however, even if people are eligible for health coverage, they do not enroll. One of the reasons often given is the complexity of the enrollment process itself.

Some people are intimidated by the complicated requirements to apply. Others may not speak English so the enrollment forms can be difficult or impossible to understand. Translation services can be limited. Individuals struggling with mental illness or substance use disorder or other chronic conditions might struggle to obtain the many documents needed to prove eligibility.

This is an issue that those working on the delivery of health care to low-income and vulnerable people have puzzled over for some time. The agencies that provide such coverage, such as state Medicaid programs, have tried to address the issue by providing funds to local nonprofits for outreach and enrollment.

Our foundation has done this as well, through our “Connecting Consumers with Care” grant program. Each year, we provide grants to 15 community-based organizations to reach uninsured people who are eligible for Medicaid (called “MassHealth” in Massachusetts) and other programs and help them secure that coverage.

Since November 2017, our grantees have helped over 15,000 new applicants seeking MassHealth or other publicly subsidized health insurance coverage and over 22,000 people keep themselves and their families covered.

How do they do this? By going to places where people are – where they shop, where their kids are in school, where they worship – letting them know what programs exist, and then helping them fill out the application and get all of the documents they need. The goal of the work is to bring these programs directly to people so it will be easier to apply and get coverage.

Aside from getting access to coverage, our grantees help individuals and families to stay covered by helping them when it is time to renew their enrollment. Experiencing gaps in insurance coverage is problematic because it leads to inconsistent medical care. Individuals who have chronic medical conditions need regular care in order to stay well.

Our foundation’s grantees, including Brockton Neighborhood Health Center, are finding innovative ways to reach the uninsured to get enrolled as well as to prevent people from losing coverage and thereby needing to start the enrollment process all over again.

In Brockton, a city of nearly 100,000 residents located 24 miles south of Boston, there are many barriers to getting health care. The city has a high poverty rate, with more than three-quarters of the students in the school system considered to be low income and the city’s rate of uninsured residents surpasses the state average. A quarter of the city’s population was born in another country, so there are a significant number of residents for whom English is not their first language.

Brockton Neighborhood Health Center, which serves over 35,000 residents of the area, has an enrollment and outreach team of 13 – all of whom speak two or three languages – that works directly with individuals who may be eligible, to educate and enroll them. Their activities range from what you might expect, such as staffing tables at key locations, to what you might not: reaching out to people in advance of their insurance renewal dates and helping to obtain the paperwork – including residency and tax documentation – they might need for the process.

These health center staff partner with individuals and serve as a go-to resource to help resolve any problems during their enrollment process.

“We have been doing this work for years and you might think the need would peak and then plateau, yet we still get flooded with people in need of help getting covered,” says Susan Joss, Brockton Neighborhood Health Center’s CEO.

Outreach and enrollment is a key component of the hard work of reducing the rate of uninsured and it cannot be overlooked. People’s health and the well-being of the health system rely on it.

Audrey Shelto is president of the Blue Cross Blue Shield of Massachusetts Foundation, a private, nonprofit organization whose mission is to expand access to health care for low-income and vulnerable people in the commonwealth.